Risks of AKI and Major Adverse Clinical Outcomes in Patients with Severe Acute Respiratory Syndrome or Coronavirus Disease 2019

Significance Statement The effects of AKI on clinical outcomes of severe acute respiratory syndrome (SARS) and coronavirus disease 2109 (COVID-19) are unclear. The authors? territory-wide, retrospective cohort study showed higher rates of AKI and major adverse clinical outcomes among patients with SARS than in those with COVID-19. Among patients with either of these two coronavirus infections, patients with diabetes mellitus, abnormal liver function, or AKI were significantly more likely to have major adverse clinical outcomes. Diabetes mellitus and hypertension were significant factors that were associated with AKI in patients with either SARS or COVID-19. Among patients with AKI, those with COVID-19 were less likely have major adverse clinical outcomes compared with patients who had SARS. In patients with either SARS or COVID-19, renal function usually recovered within 30 days of an initial AKI event. Background Severe acute respiratory syndrome (SARS) and coronavirus disease 2019 (COVID-19) are closely related. The effect of AKI on the clinical outcomes of these two conditions is unclear. Methods This retrospective, territory-wide cohort study used an electronic public healthcare database in Hong Kong to identify patients with SARS or COVID-19 by diagnosis codes, virologic results, or both. The primary endpoint was a composite of intensive care unit admission, use of invasive mechanical ventilation, and/or death. Results We identified 1670 patients with SARS and 1040 patients with COVID-19 (median ages, 41 versus 35 years, respectively). Among patients with SARS, 26% met the primary endpoint versus 5.3% of those with COVID-19. Diabetes mellitus, abnormal liver function, and AKI were factors significantly associated with the primary endpoint among patients with either SARS or COVID-19. Among patients with SARS, 7.9%, 2.1%, and 3.7% developed stage 1, stage 2, and stage 3 AKI, respectively; among those with COVID-19, 6.6%, 0.4%, and 1.1% developed stage 1, stage 2, and stage 3 AKI, respectively. In both groups, factors significantly associated with AKI included diabetes mellitus and hypertension. Among patients with AKI, those with COVID-19 had a lower rate of major adverse clinical outcomes versus patients with SARS. Renal function recovery usually occurred within 30 days after an initial AKI event. Conclusions AKI rates were higher among patients with SARS than those with COVID-19. AKI was associated with major adverse clinical outcomes for both diseases. Patients with diabetes mellitus and abnormal liver function were also at risk of developing severe consequences after SARS and COVID-19 infection.

Automated summary

The study found that patients with SARS had higher rates of acute kidney injury (AKI) and major adverse clinical outcomes compared to those with COVID-19. Diabetes mellitus and hypertension were significant factors associated with AKI in both SARS and COVID-19 patients. Patients with AKI in COVID-19 had lower rates of major adverse clinical outcomes compared to those with SARS, and renal function typically recovered within 30 days after an initial AKI event in both groups.